ClickCare Café

What Is Your Most Precious Resource for Telemedicine?

Posted by Lawrence Kerr on Thu, Apr 19, 2018 @ 06:00 AM

kazuend-32605-unsplashHealthcare today is under such pressure that every resource we have seems in short supply. 

Time, supplies, patience, money, access to tools, and even patients all seem scarce at times, and many of us are under intense pressure to manage them. 

A recent article in the New England Journal of Medicine, however, used data to shed light on the question of what our most precious resource truly is... and how we might manage that resource more skillfully.In the April 19th, 2018 issue of the New England Journal of Medicine, researcher Graham McMahon, MD, MMSc looks at a set of data for residents' duty schedules. 

The primary purpose of the study, the iCOMPARE study of residents, was to compare two duty-hour schedules -- a more traditional set structure and a more flexible structure. 

The results seemed to indicate that overall, the more flexible structure was much more successful. But that depended a lot on the speciality of the resident (internal medicine vs. surgery, for instance). 

More interestingly, the author drew some fascinating insights from the study about how we value healthcare professionals: "Many healthcare institutions appear to have lost sight of the truism that our health professionals are our most precious resource.”  He also says that many healthcare professionals have lost the spirit of "volunteerism and soul" that has so animated our profession for so long. 

Specifically, he looked at how the shift structure affected burnout quite dramatically. In fact, just the change in shift structure resulted in more than 2/3 of residents reporting high or moderate levels of emotional exhaustion, depersonalization, and low perceptions of personal accomplishment. McMahon explains, "Burnout among health care professionals is generally attributed to work-related factors, such as overload, loss of meaning, and lack of autonomy, and ultimately affects many dimensions of care quality, including rate of error, patient mortality, teamwork, malpractice suits, patient satisfaction, productivity, and costs.”

But McMahon is careful to not imply that shift structure in itself is what needs changing. He emphasizes that regulatory expectations may need to differ across specialities and that training organizations should, above all, examine how they are:

  • Funding and supporting educators and mentors
  • Supporting and managing individual growth
  • Providing sufficient time for electives and remediation
  • Creating work environments that promote deliberate practice, reflection, and feedback without excessive clerical or clinical burden.

McMahon's most emphatic insight, however, is that healthcare organizations must prioritize people. He argues that the concerns and experience of healthcare professionals isn't a "side effect" or an ancillary concern -- these things are central and primary to the mission of those organizations.

This certainly resonated with our experience, as well. So many organizations spend huge amounts of time and money on complex hardware installations for projects like telemedicine, without really considering the usability and sustainability of the system -- they don't stop to consider people. It's assumed that provider schedules will accommodate videoconferencing, that people should be able to learn difficult interfaces, and that providers need to adapt to the project (not the other way around.)

Whether it is for telemedicine or training, our most precious resource is people. Not hardware. Not time. Not money. People. Because if the people are inspired, and trained, and allowed to work as a team, they will thrive and patient results will flourish. That's why when it comes to telemedicine, we believe organizations should spend less time and money on hardware and more time and money exploring the best workflows, interfaces, and simple tools to support people in working together in the ways that they want to.

So, choose systems and tools that acknowledge that people are important -- and that put people first in how those tools work and what they do. 

For a people-centric model of telemedicine, check out hybrid store-and-forward telemedicine: 

ClickCare Quick Guide to Hybrid Store-and-Forward


Tags: hybrid store and forward medical collaboration, medical education

Healthcare Collaboration May Be World-Changing But It Can Be Very Personal Too

Posted by Lawrence Kerr on Tue, Apr 17, 2018 @ 06:00 AM

aditya-romansa-117344-unsplashWhen people consider becoming healthcare providers, it’s sometimes the “big things” that they think of. Saving a child’s life. Groundbreaking research. Dramatic diagnoses.

But the truth is that for many of us, the part of medicine that is most satisfying is actually the “little things.” A patient’s shy smile when she learns she can play in Friday’s game. A new mom’s growing confidence. Getting a a referral for a patient fast, with just the right combination of phone calls and sweet-talking.

In this age of patient satisfaction surveys, relentless metrics, and widespread provider burnout, we can forget that for patients, it’s actually the little, human things that matter most to them, too.

I read a beautifully written narrative recently that brought this dynamic to life for me. 

The author, Lisa Rubisch, a mom with a year-old baby, had a benign cyst in her uterus that she needed removed with surgery.

A person who was generally nervous with medical procedures, Rubisch felt especially vulnerable, since she had given birth to her young son not too long beforehand.

Once wheeled into the OR, Rubisch found that the team was playing Led Zeppelin on the overhead speakers. It was harsh, heavy music to her ears and unnerved her further.

“You don’t like Zeppelin?” a nurse asked, in his thick Queens accent. “Who do you like?”

I heard myself muttering the first band that came to mind: “The Beatles?”

Someone actually left the room in search of a Beatles CD but returned empty-handed.

“Well, I guess we should just call the whole thing off,”  I said, laughing nervously.

They stood around me in awkward silence. I could see in their faces how much they wanted to soothe me; they were all trying so hard to be cheerful and upbeat, but the truth was, the show must go on.

Then, from somewhere behind me, outside my peripheral vision, a lone male voice started to sing. “In the town, where I was born… lived a ma-a-an who sailed to sea…”

He was slowly joined in chorus by the other surgeons, nurses, assistants and anesthesiologists, in what was possibly the strangest, sweetest, most tuneless version of Yellow Submarine ever to be sung. “…and he told us of his life in the la-a-and of submarines…”

The whole surgical team singing an off-key Beatles song was a “little thing.” A medically unimportant, human moment that struck Rubisch in a profound way. As she put it, “When placing your life in someone’s hands, you want to know that they are particularly skilled hands. You want the best surgeon that exists in the universe. But beyond skill, beyond technology, medicine and state-of-the-art equipment, the thing that you remember long after you’ve healed is human compassion.”

So ultimately, the “little things” aren’t so little.

Knowing your patient as a person and understanding the social and economic and personal context of their life allows you to create these moments of human compassion. We talk a lot about telemedicine-based healthcare collaboration as a tool that does big things: cuts costs, saves lives, and creates a new way of doing medicine. But the truth is that doing healthcare collaboration with telemedicine allows us to do the little things too: to care for patients in ways that are meaningful to them — and satisfying to us.

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration software, healthcare collaboration

Are Primary Care Doctors Being Replaced By Urgent Care?

Posted by Lawrence Kerr on Wed, Apr 11, 2018 @ 06:01 AM

filip-mroz-172352-unsplashThe time when each family had a family doctor isn’t long behind us.

When my parents were growing up, it was common for the family doctor to know your parents, kids, cousins, and neighbors; to make house calls; and to take your full situation (social, economic, cultural, familial) into consideration in treatment. Of course, payment might be made in dollars, insurance, or chicken eggs.

That time in medicine, of course, is gone. While some elements of this system are having a rebirth (like the dawn of the concierge family doctor), the structures that supported it have crumbled.

Until recently, though, primary care doctors have been a core part of the healthcare system, and the foundation of most people's experience as patients. Primary care doctors, of course: 

  • Give continuity of care, remembering your last visit and your overall life situation, embedding their perspective in these elements 
  • Coordinate care, playing the role as the key intersection point among specialists and family and patient.
  • Tend to have long-term incentives, meaning their motivation is usually providing the right care over the long term, not necessarily providing a quick fix. 

Recently, as the New York Times investigates, urgent care and "minute clinics" have begun to supersede primary care doctors as the first place people go when they need medical care. There are 12,000 across the country and as visits increase, visits to primary care doctors have dropped. There are multiple factors that contribute to this, including the key advantages of urgent care or retail clinics: 

  • Expanded office hours, which often coincide with hours that busy working people are available.
  • Affordable, clear fees.
  • Perception of faster results and more streamlined treatment. 

There certainly is no replacement for a caring doctor who can truly care for you and understand the context of what you’re going through. Many in the healthcare field worry that outcomes will be worse from urgent care approaches, that antibiotics may be prescribed unnecessarily, and that key conditions or issues may be missed. Plus, fast isn’t always better — or cheaper. “None of the research has shown any of these approaches to delivering care has meaningfully addressed cost,” Dr. Werner said in the New York Times.

That said, even the best primary care doctor doesn’t eliminate the need for excellent care coordination and healthcare collaboration. For many years, the primary care doctor seemed like the panacea for coordinated, thoughtful care. But in reality, so much has fallen through the cracks for so long. And overloaded providers struggle to do healthcare collaboration and care coordination in the right ways. 

So much is lost when we transition from primary care doctors to urgent care clinics. But something might be gained as well. Perhaps, as the traditional structures of healthcare change, doctors and patients may begin to be more open to new solutions. Demands for speed and efficiency are exposing the weaknesses of the old system, certainly -- it's up to us whether we rise to the occasion and create better things to replace what's no longer possible to depend on. 


For more stories of how people are using telemedicine to move forward in healthcare, download our quick guide: 

ClickCare Quick Guide to Telemedicine


Tags: direct primary care, care coordination, emergency medicine, healthcare collaboration software

How Aboriginal Healers Do Healthcare Collaboration for Complementary Medicine

Posted by Lawrence Kerr on Thu, Apr 05, 2018 @ 06:00 AM

joey-csunyo-512460-unsplashLyn Ackerman has had 9 heart attacks and an infection she contracted from surgical tools. But she says that one of her biggest challenges has been being far from her community. 

She's also indigenous and is similarly distanced from her culture every time she goes into the hospital. Even waiting for an appointment has felt alienating and treatment has often felt irrelevant, far from the healers that she says many indigenous people are more familiar with. She said, "The healers' power for Indigenous people lay with their ability to reconnect them to culture, the lifeblood of their spiritual being."

This sense of alienation, as well as poor health outcomes, has continued until a new program was implemented in a local hospital. And for Lyn, everything started to turn around.

This new program is bringing aboriginal healers (Ngankari healers) -- whose tradition goes back 60,000 years -- into hospitals across Australia.

The healers work separately but in collaboration with conventional healthcare providers, in the hospital or clinic setting. As ABC reports, Ngangkari healers use their hands to, as they describe it, move energy and spirit. It's been shown to alleviate pain symptoms. 

One indigenous woman said, "I'd rather go to the Aboriginal clinic where you sit back, can have a yarn, catch up with family and friends." In other words: I prefer medical care when there is a connective, socially embedded component. And one of the biggest impacts of the program has been improved attendance rates. People comply with medical treatment when they feel it is appropriate to their lives and working in the ways they want it to.

It's an example of both complementary medicine and healthcare collaboration. Healers certainly don't replace conventional medicine in the hospital setting. And the doctors and the hospital aren't excluding the healers. Instead, each modality is respected as an important part of the whole picture for patients who may struggle with the way conventional medicine intersects with their beliefs and experience. And the program is in place to support appropriate elements of the team in providing and coordinating care. Of the Ngangkari healer program, Jon Wardle, a senior lecturer in public health at the University of Technology Sydney says: “Including healers in a hospital setting could also reduce the risks alternative medicine could have, such as physical trauma caused by under-qualified therapists, or interactions with prescriptions drugs if a patient was offered herbal medicine.”

This setup might seem a world away for many of us, with little experience of traditional healers. But the importance of having a holistic social/cultural/emotional view of care as well as a more expansive understanding of the medical team, is crucial for many patients. It's a dynamic that comes up for the high school athlete who has to miss games to travel to a specialist appointment three counties away -- and who would do better with compliance if his doctors were collaborating. Or the older gentleman who needs a change to his medication and may not come in if he feels like the doctor hasn’t understood the full scope of his challenges and can't get the social worker and doctor on the phone together.

Of course, the most commonly thought about forms of complementary medicine are things like acupuncture. Many of these "complementary" treatments are sidelined, and healthcare collaboration with doctors or the conventional medical team doesn't happen. Because of this shortcoming, treatment or medication conflicts can occur, and patients may be less compliant. Because of our limited idea of the "medical team" and our limited tools to do healthcare collaboration, care suffers.

When more people are part of the medical team, more modalities can be used to care for the patient. And that's always a good thing. The more integrated the team is, the more divergent but complementary the viewpoints, the more progress can be made. I think we can all learn from the Ngangkari healers and their doctor colleagues -- and I believe that we can all find ways to work together, whatever our context.

Try a tool that lets you collaborate with colleagues, especially in complementary medicine contexts:

Try the iClickCare 14-day evaluation

Tags: care coordination, healthcare collaboration

The Surprising Result of a Study on EMR-Related Medical Errors

Posted by Lawrence Kerr on Wed, Apr 04, 2018 @ 06:00 AM

andrew-pons-6488-unsplashElectronic Medical Records are one of the most frustrating parts of every healthcare provider's day. 

EMRs are notorious for being difficult to use and to make do what you want, and they impinge on our ability to be present with patients. 

I think most healthcare providers instinctively feel that the EMR is, overall, a net negative in the way they care for their patients. But a new study has some surprising results that may shock any provider who uses an EMR intensively. 

The sense that Electronic Medical Records are taking a toll on medicine is one thing. But a team of researchers who published their results in JAMA recently decided to quantify that toll. The researchers looked at 1.7 million patient safety incidents reported to the Pennsylvania Patient Safety Authority and from a large multi-hospital academic medical center between 2013 and 2016. They were trying to codify whether the safety reports were linked directly to an issue of EMR usability. 

The results are surprising. As Fierce Healthcare summarizes, "The authors found just 0.11% of events explicitly mentioned an EHR vendor or product and just over 500 events (0.03%) includes language explicitly referencing EHR usability."

In other words -- barely any of the incident reports related to the EMRs being hard to use. 

When I read this, I furrowed my brow, not quite believing the results. The data was surprising, given my and my colleagues' felt experience with EMRs. We'd expected that many incidents would arise in one way or another from the EMRs' lack of usability.

The JAMA study defines Electronic Health Record (EHR) usability as "the extent that EHRs support clinicians in achieving their goals in a satisfying, effective, and efficient manner." Even reading that sentence puts a spotlight on current shortcomings. Few providers feel their EHR lives up to that standard. 

Sure, the study design may have created far too conservative a standard for linking the patient safety issues and EHRs. (The standard was that the vendor or product be mentioned by name, which may well be unlikely even if the EHR's usability contributed to a safety incident.) But what I found even more interesting was simply my reaction to the study. I was very surprised that there weren't more related safety incidents; in fact, even the study's authors seem incredulous at the results, trying to explain why they were so low: "Broadly, patient safety incidents are notoriously underreported, and the likelihood that a clinician would include the name of the EHR vendor tightens those parameters even farther."

Our tools are so difficult to use that we think they are putting our patients in danger -- this is sobering to realize. in contrast, we made iClickCare so intuitive, so visual, and so simple that anyone understands it easily, within seconds of opening the program. And that's not because we're better funded than the entrenched EMR vendors -- it's because we care and because we have a medical and a software background. 

It's time for us to demand more from the tools we use. And if your telemedicine platform or electronic health record isn't fully useable and supportive of your practice, it's time that you start demanding changes. 


Signup for an iClickCare Account

Tags: telemedicine solutions, healthcare collaboration software

Evidence-Based Analysis of Healthcare Costs -- and The Role of Telemedicine

Posted by Lawrence Kerr on Wed, Mar 28, 2018 @ 06:00 AM


The most common questions that we get about iClickCare are related to cost and ROI.  What is the return on investment of telemedicine? Can doing healthcare collaboration bring additional income into the organization? Will iClickCare help us cut costs? (To which we answer: the ROI is excellent; definitely; and for sure.)

It makes sense, given the cost pressures that providers, practices, and hospital systems face these days. So much of what we do boils down to cutting costs or increasing income for the institutions that we work for.

This focus on costs makes sense in a lot of ways. But it is also a shame, given the profound impacts of using telemedicine for healthcare collaboration that go far beyond cost savings. Ultimately, for us, iClickCare is about good medicine, not just good economics. We find that healthcare providers, who do telemedicine and do healthcare collaboration, experience less burnout, better outcomes, AND increased income and decreased costs. It simply goes back to providing the best care that we possibly can for our patients: a principle we all learned in medical school.

That said, we were intrigued by a recent study that gets deep into healthcare costs in the US — with some surprising conclusions. Fierce Healthcare elaborates on the study by Papanicolas et al., which was published in the Journal of the American Medical Association last week. It's an exploration that lends some good science to the conversation around costs.

There are fascinating findings, some of which debunk drivers of healthcare that we tend to take as “obvious” causes of high costs. Conventional wisdom says, "Sure, medicine in the US is more expensive than in other places, but outcomes are better, and the costs generally come from use of high-tech interventions and pro specialists." 

The reality is more complicated than that. In 2016, the US spent 17.8% of its GDP on healthcare. That's significantly higher than in the 10 other high income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) that the study looks at. Expenditures in those countries range from 9.6% (Australia) to 12.4% (Switzerland). And, sadly, life expectancy (perhaps a proxy for outcomes, or perhaps not) is lower in the US than it is in the rest of these high-income countries.

The first focus of the study was the source of these high costs. As the study authors report, “Administrative costs of care (activities relating to planning, regulating, and managing health systems and services) accounted for 8% in the US vs a range of 1% to 3% in the other countries.” It turns out that it is precisely these administrative costs, alongside pharmaceutical costs, that account for the total cost difference in the US relative to the other countries -- not costly specialists or expensive procedures. 

The study certainly raises important questions about value. And the conversation around evidence-based approaches to costs is hugely important. It's certainly detrimental to our field that we often don't tend to apply the same amount of rigor to analyses of costs and drivers as we do to the content of our medical practices. Ultimately, cost concerns drive the context in which healthcare providers work, so it's crucial that we understand these costs accurately.

But there are no easy answers. Why do we spend more on administrative costs of care? Is it because we're failing at care coordination and healthcare collaboration or is it for another reason? Why is our life expectancy lower? Is it because of poor outcomes relative to the other countries, or does our heterogenous country have different starting points than these other countries (as just one example of an additional explanatory factor.) 

While fascinating and helpful, the study certainly doesn't give us simple conclusions. It's an important conversation to be having, but it's also important not to jump to knee-jerk responses that don't really support us in moving forward.

As healthcare providers, most of what we can control is just in our patient-by-patient decisions, trying to improve care, bringing down the time that we spend playing phone tag or coordinating care, and improving outcomes. And ultimately, that may make the biggest difference of all.


Get an honest review of one of the most cost-effective telemedicine approaches available, here:


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine technology, healthcare collaboration software, cost effectiveness

 The Provider Shortage Mistake Your Hospital is Making

Posted by Lawrence Kerr on Thu, Mar 22, 2018 @ 06:00 AM


Many healthcare providers feel undervalued, unappreciated, and overworked.

(“Yeah,” I can hear you saying, “Name one provider that doesn’t feel that way!”)

I know that for many providers, it feels like their work is disposable, that it’s not valuable, and that they’re a cog in the wheel.

In reality, however, healthcare providers are in short supply and of extreme value to hospitals. In fact, the cost of replacing a physician is estimated to be $500,000 to $1 million. And Fierce Healthcare reports that the provider shortage is bad and getting worse. They quote Bill Haylon, CEO of Leaders for Today as saying, “The findings tell us is that there simply isn’t enough qualified talent to go around and that frustration levels are rising."

So you would think that the healthcare system, in particular major hospitals, would be "all hands on deck" to retain their healthcare providers and to leverage their time and expertise.

In reality, my observation is that hospitals simply aren't doing enough to retain their providers. In 2014, 54% of U.S. physicians reported burnout, much of their frustration coming from ever-increasing clerical loads. Of course, physicians with symptoms of burnout are more likely to report having made a major medical error in the past 3 months and to receive lower patient-satisfaction scores. Many, perhaps most, feel under-appreciated, under-supported, and overworked.

Further, most medical practices and hospital systems are not leveraging their providers' time with hybrid store-and-forward telemedicine or healthcare collaboration. The pressure on providers to perform at the highest levels, with no mistakes, is high. But the tools provided to support care coordination or healthcare collaboration -- which can reduce workload, and decreased mistakes, while easing burnout -- are inadequate. 

We believe that the key challenge here is for us to connect the dots. We need to connect the dots between hiring challenges that hospital administrators face... and burnout... and the lack of healthcare collaboration tools that can significantly leverage providers time, and ease burnout. Ultimately, the right tools -- like healthcare collaboration using iClickCare Hybrid Store-and-Forward® -- can make the challenges around the provider shortage much less severe.

To learn more about how to start a program at your hospital, download our free guide: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: healthcare provider burnout, provider burnout, healthcare collaboration software

Why The Pay Gap for Women Doctors Hurts More Than Women

Posted by Lawrence Kerr on Wed, Mar 21, 2018 @ 06:00 AM

rawpixel-com-267082-unsplash.jpgWhen our founder, Cheryl, went to medical school, there were only 5 women in her medical school class. (Actually our medical school class since both of us were in the same medical school class and shared a cadaver.)

Things have certainly changed since then, in some ways for better and in some ways, for worse.

Although Cheryl’s medical school class only had 5 women in it, in 2017’s incoming medical school classes, women made up just over 50% of students. As this is Women’s History Month, that seems a milestone worth noting. 

Surely, allowing the makeup of our doctors’ demographics to reflect the demographics of the talented people in our country is good for everyone. So the equity in representation of the genders in medical school classes is likely a step forward.

That said, I was, quite honestly, saddened and surprised to hear that female doctors earn 27.7% less than their male counterparts (an average of $105,000 less.) This number actually has increased since 2016.

The pay gap, of course, is a serious issue across all industries and physician pay aligns with the pay gap that is seen in other professions. And truthfully, the pay gap for lower-waged workers is probably more significant of a problem for those experiencing it.

But my concern about this pay gap in medicine goes beyond gender equity or salaries. My concern is greater because I believe this persistent — and growing — pay gap is representative of our tendency in medicine to devalue the contributions of some medical providers relative to others.

This instance is especially stark because the job being performed is exactly the same. So we're very obviously undervaluing the contributions of female doctors relative to male doctors.

But we do this across the medical team. We each have such unique contributions to a patient's case. When we refuse to use existing tools to do medical collaboration, we are effectively saying, "my opinion on this case is the only one that is relevant."  When we refuse to ask colleagues to collaborate, when we disregard the perspectives and input of others on the team, or when we neglect to consult on a case, we're devaluing those perspectives and the patient suffers. 

Stark data is always a chance to see where we find the same dynamics in our life or practice. So as Women's History Month comes to a close, I hope we can use it as a moment to reflect on how we might value, reward, and listen to all of the voices on the medical team, regardless of gender or title. 


ClickCare Quick Guide to Medical Collaboration

Tags: store and forward medical collaboration, hippa secure healthcare collaboration

A Definitive Guide to Healthcare Collaboration

Posted by Lawrence Kerr on Wed, Mar 14, 2018 @ 07:40 AM

HC 3.png


Introduction to this Review:

They say that the more things change, the more things stay the same. And in medicine, that's especially true.

Recent years have brought pay-for-performance systems, focus on metrics like length of stay and readmissions, and demands of care coordination and meaningful use. In turn, all of these pressures mean that healthcare collaboration is critical to surviving in today's medical landscape But, of course, the more things change, they more they stay the same. Healthcare collaboration has always been the best way to provide excellent care to our patients. So it's one of those times when the "practical thing" is also the right thing to do.

As two doctors who founded a telemedicine-based healthcare collaboration platform, we're deeply passionate about healthcare collaboration. In fact, it might just be our life's work. So this page is meant to be your "cheat sheet" to healthcare collaboration. Use it as you wish: as a review, as a checklist, as an introduction. No matter how you use it, remember that beyond technology, beyond telemedicine -- the main thing is treating our patients in the ways we would want to be cared for. And it turns out that's good medicine, good business, and good work.


Table of Contents: 


“What we have here is a failure to communicate”
1967 Cool Hand Luke, Strother Martin, Captain and Paul Newman, Luke.

What is Healthcare Collaboration?

Healthcare collaboration is simply a team, working together, as professionals, on behalf of a patient. The goal is rapid, simple, documented, interactive presentation and discourse of information pertinent to a particular health need. When appropriate, the patient is part of the team. 
Of course, healthcare collaboration is not dependent on any one kind of technology. Providers doing healthcare collaboration may use technology but it's a tool, not the purpose. It's not dependent on any one kind of expertise, either. Providers doing healthcare collaboration can bring multiple kinds of experience and expertise, from across the continuum of care. It is the sharing of expertise that brings out the best medical care, irrespective how it was done. 

The classic principles of good medical care have always involved a team approach to complex diagnosis and treatment, as well as complex psychosocial overlays to physiologic and anatomic problems. This is not foreign to us as medical providers.

In school, we used study groups to help us learn. In labs, we had partners. If you were a medical doctor, you had rounds, grand rounds and morning report. If you were a surgeon, you had morbidity and mortality conferences. If you were a Physician's Assistant or Nurse Practitioner or Aide or nurse, you certainly had the same structure and hopefully were invited to be part of the above. With the changes in medicine, the need for these supports has increase, but most of the supports themselves have disappeared.

Currently, information technology is the lens through which this simple principle is seen. That has not always been the case. The concept and assumptions are timeless. Current or historical, they use the same classic principles.  One professional has a question for another. Sometimes a simple answer is all that is needed. At other times, a discussion is needed to add judgment and experience. And still at other times, discussion is needed over time.

However, the concept has been warped by technology and by the lens through which we view the technology. We have become more “connected” but in fact we are more isolated.  A text message has room for only data or for feelings, but not both. The phrase, “I am worried about” wastes 16 characters of message space. By its elimination, it also eliminates offers of support and enhances isolation.

Many, almost too numerous to count, words are used to label the use of technology in healthcare.  For example, this thorough analysis from Ziegler,  a speciality investment bank report.  

Many descriptors are used: telemedicine, mHealth, eHealth, telehealth, synchronous, asynchronous, video store and forward, secure text, secure email, telephone call, care management, personalized health, home monitoring, telecardiology, teleneurology, telestroke, teleER, telepsychiatry, telenursing and more. They overlap.


Why is Healthcare Collaboration Necessary?

Certainly, collaboration is not always necessary. It should not just be another healthcare product but rather an assist when an extra hand is needed. But when it is necessary, it is necessary for a variety of reasons:

1. As much expertise as each of us has, we need to realize that “No one of us is as smart as all of us."

2. The amount of knowledge has exploded. No one of us can master all of it. 

3. Healthcare is complex with ambiguity, uncertainty, and a blend of too much data and incomplete data. 

4. In serving the patient, often called providing healthcare, the provider, can be lonely. Burnout, job changes and suicide rates attest to that. 

5. The patient needs access to the right care, at the right time, in the right place, as close to home as possible. 

6. Those who follow behind need education. Medical education is the least effective that it has ever been from the time of the Flexnor report of the early 20th century. 

7. Data alone is useless without interpretation. Can you interpret high normal on lab and anatomic normal on an X-Ray, always? Weeding through an EMR is both exhausting and time consuming, only allows review of data, and can be supported by extensive reading. Our expertise is needed -- and, often, the expertise of multiple people is what's needed.


What Attitude is Necessary?

Artificial intelligence will become an aide. Emotional intelligence will become a necessity.

The demands of today's medical systems mean that we work in our own silo and rarely collaborate. We have academic specialties (stroke, cardiology, neurology, etc.) and relate to only one part of the body, not to the patient as a holistic being.

So medical providers who do healthcare collaboration tend to have a unique attitude. In our work with thousands of providers in telemedicine and collaboration, we've found the following attitudes to be crucial:

1.  Yearning to do better and belief that we can do more.

2.  Sense of responsibility beyond “the job."

3.  Respect for all colleagues regardless of role, from support to ultra-specialist.

4.  Enjoyment of interaction and of being a vibrant part of a community.

5.  Recognition of the whole, rather than fixation on the part.

6.  Acceptance of the limitations of one’s self or of one’s colleagues.

7.  Attitude towards technology as a friend not an as enemy.

8.  Understanding that the patient is the boss, not the administration nor the government.

9.  Recognition that the patient is a person, not a widget to move down the assembly line.

10.  Sense of satisfaction from being part of the whole that is bigger than oneself.

11.  Desire and ability to abstract, prioritize, and communicate a question and an answer.

12. Respect for the value of coordination and at times, for compromise.


Who Benefits from Healthcare Collaboration?

Healthcare collaboration, even when done on a limited scale, has so many benefits that it's almost difficult to enumerate them.

Some of the benefits of healthcare collaboration include:

1.  The patient by receiving the best care, at the best time, in the best place.

2. The healthcare system by benefiting from efficient and coordinated care.

3.  The taxpayer who is not the victim of waste from an inefficient system.

4.  The more healthy society by having more healthy members.

5.  The payor by paying for care that is less wasteful, more accurate and more preventative.

6.  The provider by having a satisfying and supportive work environment.

7.  The family who understands, who supports, and who is free of needless burden.

8.  The student who is healthy enough to learn well and to stay in school as much as possible.

9.   The educator who gains a rich experience for review to share with others.


Who DOES NOT Benefit From Healthcare Collaboration

Of course, we all resist change sometimes. And we're all busy and selfish at other times. But we find that the benefits of healthcare collaboration tend to be so significant and so immediate, that very few providers don't benefit. 

Ultimately, only the following people tend to resist healthcare collaboration so much that they never benefit:

1.  The egotist who is no longer the narcissistic center of attention

2.  The medical center wanting to survive because of control of the catchment area

3.  The entrenched regulator who resists change (within government or within a system)

4.  The adherent to a zero sum game where one wins only at the expense of another’s loss


What Equipment Is Necessary?

Little equipment or special technology is necessary to be collaborative. That said, there are a few technological tools that can make healthcare collaboration much simpler and more practical in today's medical system.

A secure system that ensures patient privacy.

In the United States, this is described as HIPAA compliant. In Europe, it's European Union General Data Protection Regulation; in Mexico, the Federal Data Protection Act; in Canada, it's PIPEDA. Countries throughout the world have similar examples.

Software is needed to make the devices, mobile or stationary, protect patient privacy and ensure that the entire system is compliant.

The ability to share images and videos.

Rich information allows good evaluation, so text is usually insufficient. A photo of a rash, a video of gait, or an audio clip of speech can be crucial to good collaboration and diagnosis.

At times, live video conferencing is important, especially when a consultation is direct from provider to consumer, but this is not really an example of collaboration. Further, when relationships need to be developed or when voice and face are easier than typing, the live video is important.

Limited peripherals.

When equipment (often called peripherals) is needed to obtain data such as an endoscopy, then specialized equipment is important. Realize though, that once the data obtained, it can be shared by a healthcare collaboration system.

Internet Connection.

An internet connection, slow or fast, is necessary if modern technology is going to be leveraged. However, stopping a colleague in the hall or on a telephone call is also healthcare collaboration. But one might not be in the hall at the right time or able to take on the phenomenal burden of telephone tag -- which is why it can be helpful to have a technology tool to help with the coordination and communication.

Specifically, the components of the needed equipment include:

1.  The desire and need to collaborate

2.  Connectivity

3.  Secure, comprehensive software platform (asynchronous, store-and-forward)

4.  Secure video-conferencing system (on occasion)

5.  Policy and procedures

6.  A system that is easy to use, always on, always available (for instance, a smartphone)


What About Policy And Procedures?

Seven main components need to be in place. They need not be complex, but should be tended to to ensure compliance:

1.  Reimbursement policy and procedures.

2.  Privacy procedures consistent with HIPAA.

3.  Bring Your Own Device (BYOD) policy.

4.  Patient permission policy.

5.  Policy about access to records with change in employment.

6.  Electronic orders.

7.  Delineation of responsibility.


What Is Needed From Leadership?

Of course, there are many leaders in every healthcare community. Aides, family members, nurses, doctors, administrators, and specialists are all leaders at different times and in different ways. But many times, medical providers get stuck in their efforts to collaborate because they don't have the support they need from "official" leaders -- department heads, hospital administrators, and the like. Medical providers can also be buoyed and championed by forward-thinking hospital administrators (of which there are many), something we've certainly seen and experienced over and over again. 

Medical leadership can offer the following to support healthcare collaboration efforts:

1.  Acceptance of something new and willingness to change

2.  Commitment to making healthcare collaboration work

3.  Encouragement and enforcement of use

4.  Strong support of implementation

5.  An empowering attitude

6.  High level understanding of workflow and its challenges

7.  Broad view of ROI and the changing reimbursement landscape.

8. Pride in accomplishing improvement over operational status quo.

9. Trust in downstream integrity

10. Willingness to make a decision (take a risk) before others in the industry


What are Examples Of Good Healthcare Collaboration?

Despite what skeptics may say, there is excellent healthcare collaboration happening all around the country, every single day. We see so many examples of incredible collaboration, including:

1.  School-based healthcare.

2.  Connected health.

3.  Cleft and Craniofacial Teams.

4.  Rehabilitation teams.

5.  Developmental teams.

6.  Clinical-pathological conferences.

7.  Tumor Boards where clinicians, researchers and lab colleagues discuss cancer care.

8.  Burn centers where intensity varies from ultra-acute to chronic care.

9.  Space medicine where many need to tackle the unknown at the limits of mankind’s habit.

10.  Transplant medicine where molecular biology works with surgical skill and pharmacology.

11.  WWII Valley Forge Hand Center where multiple specialists came freely and shared in care.

12.  WWI Harold Gillies Facial Reconstruction team where devastating facial injuries met artist and surgeon.


What are Examples of Poor Healthcare Collaboration?

There have also been some false starts and failures along the way as medical providers have tried to do healthcare collaboration and failed, or as people have willfully ignore the opportunity to work together altogether. For instance: 

1.  Development of anesthesia where fight over ownership slowed adoption.

2.  Semmelweis’s prevention of puerperal fever which was demeaned by the establishment.

3.  Banning of reconstructive breast implants because of a single approach to the complex.

4.  Patenting of medical advances such as cataract procedures.

5.  Various centers based on self promotion, look to the billboards and TV for the list.


How Do I Implement A Healthcare Collaboration Program?

If you're a medical provider or a healthcare administrator and you're interested in starting a healthcare collaboration program, then we are thrilled to help in any way we can. We've seen thousands of programs implemented and found some key steps to help you along the way. 

Keep in mind:

1.  Consider starting at a hotspot with fewer than 30-50 people involved.

2.  Plan and purchase for build out within 45 to 90 days to enable the network effect.

3.  Build collaborative networks based on already trusted colleagues.

4.  Continue support after introduction.

5.  Use train-the-trainer approaches so that there may always be local expertise.

6.  Budget less than one hour exposure for each participant to keep things simple.

7.  Allow self study and for medical providers to work at their own location and timing (as with hybrid store-and-forward technology.)


Key Outcomes of Healthcare Collaboration

There are many reasons to prioritize healthcare collaboration in your practice, hospital, or workday. Chief among them is the satisfaction, decreased burnout symptoms, and overall joy that providers tend to get from working together on cases.

But you'll notice a lot of other benefits as well, and the following overview of the key benefits may be a helpful outline for you as you share the potential of healthcare collaboration with colleagues... or even to be used as a checklist for assessing progress and results.

I. Cost

A.  Avoid duplication

1. Tests

2. Procedures

3. Sorting out of complications (i.e. reddened IV sites

4. Order and ranking of testing done with expert guidance

5. Avoid referral to wrong place

B.  Efficiency

1. Throughput in Emergency Department

2. Throughput in Operating Room

3. Shorter Length of Stay

4. Faster communication among unit or team members

5. Shorter work time (store-and-forward)

6. Change of diagnosis and testing from “shotgun” to precision

7. Imaging and Lab results easily placed into appropriate clinical history 

C.  Income

1. Larger catchment area can be served

2. Increasingly billable services

3. Value-based care

II.  Quality

A.  Safety

1.  Handoff errors reduced or eliminated

2. Reference and saving of more informal communication

3. Inappropriate, but still dangerous, testing, reduced

4. Rapid secure communication of environmental or infectious events

5. The potential for understanding trends with AI analysis of conversations

B.  Provider employee support and satisfaction

1.  Decrease burnout of isolation

2. Increase educational opportunities

3. Remove nagging doubt

4. Increase satisfaction of job well done by short and long term follow-up

5. More rapid on-boarding based on case review and store-and-forward methods

C.  Public health

1.  Increase communication across entire community of providers

2. Allow on-site care of patients by first responders

3. Better triage in disasters

4. Population health analysis

III.  Patient

A.  Patient understands thought process behind advice

B. Patient appreciates effort on their behalf

C. Patient can be part of the process (part of the solution, not the problem)

D. Patient avoids time off from work or school for self for some follow-up

E. Patient avoids time off from work or school while caring for child or parent

F. Patient avoids repeated history as thread of conversation unfolds




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Tags: healthcare collaboration software, medical collaboration tool, hippa secure healthcare collaboration

Looking to the Future of Medicine: Machine Learning, Telemedicine, and iClickCare

Posted by Lawrence Kerr on Wed, Mar 07, 2018 @ 06:01 AM

markus-spiske-187777-unsplash.jpgWe’ve heard key investors say that the biggest startups over the next 10 years will be those that follow the model, “machine learning + _____________.” In other words, the future’s biggest companies will be innovating at the intersection of computer’s intelligence and human reality and wisdom.

Similarly, many people who look to the future of medicine see healthcare being increasingly supported — perhaps in profound or even dominant ways by computer diagnosis.

iClickCare, of course, is medicine supported by technology, also. And a big part of our work is finding the right balance and interaction between people and the technology. Our interface is meant to minimize the feel of using technology while maximizing the “behind the scenes” work that the technology is doing to support the collaboration and coordination. It’s sophisticated, patent pending technology that feels deeply simple to the healthcare providers that use it to collaborate.

This week, we were both saddened and inspired to hear about the recent passing of Catherine Wolf, a scientist who focused her work on the interactions between computers and humans. She was a forerunner in her field, working at IBM’s Thomas J. Watson Research Center and helping develop voice-recognition systems as well as early “picture phones” and cellphones.

She also was diagnosed with ALS 22 years ago, giving her firsthand experience of using computers to communicate when her mobility was limited to an eyebrow raise. She continued to work, innovate, and to write, learning to use technology as adaptations to allow her to continue to thrive.

Her story reminds us of the profound potential of the “collaboration” between humans and computers. We’re reminded of how much we’ve progressed in the last few decades and we imagine how much more potential there is.

We’re inspired by the potential for deeper humanity, creativity, and contribution, as exemplified both by Wolf’s work as well as her life.


For an in-depth look at why we choose the technology we did for iClickCare, and how it "gets out of the way" of the people using it, download our free Quick Guide: 


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine technology, store and forward medical collaboration

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